Heartburn — that burning sensation rising from the stomach into the chest and throat — affects around 1 in 5 UK adults regularly. Despite its name, it has nothing to do with the heart. It’s an acid problem, and fortunately one that responds well to lifestyle changes and OTC treatment for most people.

What Actually Causes Heartburn?

At the junction between the oesophagus and the stomach sits a muscular valve called the lower oesophageal sphincter (LOS). When functioning correctly, it opens to allow food into the stomach and closes to prevent stomach contents — including acid — from travelling back up. Heartburn occurs when this sphincter relaxes inappropriately or becomes weakened, allowing acidic stomach contents to reflux into the oesophagus, which lacks the protective lining of the stomach. The resulting chemical burn on the oesophageal lining is what produces the characteristic burning pain. When this happens frequently, the condition is called gastro-oesophageal reflux disease (GORD).

Common Triggers

Many people find their heartburn is reliably triggered by specific factors. Common culprits include: large meals (distend the stomach and increase pressure on the LOS), fatty and fried foods (delay stomach emptying), spicy foods, tomato-based foods and citrus, chocolate and mint (both directly relax the LOS), alcohol (relaxes the LOS and stimulates acid), coffee and other caffeinated drinks, lying down or bending over after eating, smoking, excess body weight (abdominal fat increases intra-abdominal pressure), and tight-fitting clothing around the waist.

OTC Treatment: Which Medicine Works?

Antacids (Gaviscon, Rennie, Tums) work within minutes by neutralising existing stomach acid. They provide rapid but short-lived relief (30–60 minutes). Gaviscon forms a raft of alginate on top of stomach contents, creating a physical barrier that reduces reflux — making it somewhat more effective for reflux specifically than simple antacids. Best used for infrequent, predictable symptoms (e.g. after a large meal or alcohol).

H2 receptor antagonists (ranitidine was withdrawn; famotidine is now available OTC as Pepcid) reduce stomach acid production by blocking histamine H2 receptors on stomach cells. Onset within 30–60 minutes; duration 6–12 hours. More effective for moderate or frequent symptoms than antacids.

Proton pump inhibitors (PPIs) — omeprazole 20mg (Nexium Control, Pyrocalm) and pantoprazole (Pantoloc Control) are available OTC. These are the most powerful acid-reducing medicines. They block the proton pump that produces acid, reducing acid secretion by 90%+. They take 2–3 days to reach full effect but provide sustained 24-hour cover. Recommended for GORD symptoms occurring on 2+ days per week. Use for maximum 4 weeks OTC; longer use should be under medical supervision.

Lifestyle Measures That Genuinely Help

Eat smaller, more frequent meals. Don’t lie down for at least 2–3 hours after eating. Elevate the head of the bed by 15–20cm (using bed risers or a wedge pillow — adding extra pillows is ineffective as it flexes the torso rather than raising the oesophagus). Avoid trigger foods. Lose weight if overweight — even modest weight loss significantly reduces reflux. Stop smoking.

When Heartburn Needs Medical Assessment

See a GP if: heartburn occurs more than twice a week and isn’t controlled by OTC PPIs, there is difficulty or pain on swallowing, you have unexplained weight loss, you experience persistent nausea or vomiting, you are over 55 with new-onset symptoms, or you have symptoms that don’t clearly fit the heartburn pattern (possible cardiac, oesophageal or other cause).

Browse Heartburn & Indigestion treatments at Huncoat Pharmacy. Related: Gut Health Guide, Managing IBS.

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